CT of Gastric Emergencies

Abstract

Abdominal pain, nausea, and vomiting are common presenting symptoms among adult patients seeking care in the emergency department, and, with the increased use of computed tomography (CT) to image patients with these complaints, radiologists will more frequently encounter a variety of emergent gastric pathologic conditions on CT studies. Familiarity with the CT appearance of emergent gastric conditions is important, as the clinical presentation is often nonspecific and the radiologist may be the first to recognize gastric disease as the cause of a patient's symptoms. Although endoscopy and barium fluoroscopy remain important tools for evaluating patients with suspected gastric disease in the outpatient setting, compared with CT these modalities enable less comprehensive evaluation of patients with nonspecific complaints and are less readily available in the acute setting. Endoscopy is also more invasive than CT and has greater potential risks. Although the mucosal detail of CT is relatively poor compared with barium fluoroscopy or endoscopy, CT can be used with the appropriate imaging protocols to identify inflammatory conditions of the stomach ranging from gastritis to peptic ulcer disease. In addition, CT can readily demonstrate the various complications of gastric disease, including perforation, obstruction, and hemorrhage, which may direct further clinical, endoscopic, or surgical management. We will review the normal anatomy of the stomach and discuss emergent gastric disease with a focus on the usual clinical presentation, typical imaging appearance, and differentiating features, as well as potential imaging pitfalls.

Gastric ischemia due to critical stenosis of the celiac trunk

“…GI is mainly located at both the anterior and posterior gastric walls near the anastomoses between the two arterial arches over the lesser and greater curvatures 1,3 . GI results from diffuse or localized vascular insufficiency caused by different etiologies that may be classified by systemic hypoperfusion (such as shock or sepsis) or splanchnic vessel hypoperfusion secondary to gastric volvulus, acute gastric dilatation, stenosis, thrombosis, embolism, vasculitis or vasoconstriction 3,4 .…”

“…Other rare causes of GI include endoscopic interventions (endoscopic submucosal dissection, injection sclerotherapy), postoperative conditions (distal pancreatectomy with celiac axis resection, subtotal gastrectomy, highly selective vagotomy, splenectomy, gastric restrictive procedure using staplers, esophageal surgery) and even cocaine abuse 3,4 . The celiac artery is the first major branch of the abdominal aorta and gives some of the stomach blood supply through the left gastric artery and also other organs as the spleen (by the splenic artery branch) and the liver (by the common hepatic artery) 1 . Although the collateral blood supply to the stomach is protective, systemic hypotension or occlusion of the main arteries, as the case of our patient, may result in GI 2 .…”

“…2018, Vol. 41, Nº 1, enero-abril introDuction Gastric ischemia (GI) results from diffuse or localized vascular insufficiency caused by different etiologies such as systemic hypotension, vasculitis, disseminated thromboembolism or celiac or mesenteric stenosis [1][2][3][4] . We present a case of gastric ischemia due to critical stenosis of the celiac artery with an endovascular therapy approach.…”

MDCT imaging of the stomach: advances and applications

“…CT is used to investigate patients with symptoms of obstruction, pain or bleeding after gastric surgery for the detection of complications like stomal stenosis, bleeding or perforation ( Figure 17). 50 Another popular procedure for bariatric surgery is gastric banding, which involves the application formation of a small gastric pouch by application of an adjustable band, approximately 2 cm below the gastro-oesophageal junction. This gastric band may slip, owing to which the stomach may be more prone to obstruction or volvulus.…”

Will Plain Abdominal Radiographs become Obsolete?

“…37 It is usually identified as pneumoperitonem on an erect chest and/or abdominal radiograph. 38 Specific signs include Rigler sign, football sign and triangle sign.…”